After the bruising — and continuing — fight to pass and implement President Obama’s health care reform legislation, it might be tempting to take a break and claim victory. But the powerful new documentary Escape Fire, which I saw at Sundance, argues that the legal victory is only the first step on the road to a system that’s focused on patients’ overall well-being, preventative care, and breaking our dependency on prescription drugs. While none of the arguments Escape Fire makes will be unfamiliar to people who are intimately familiar with the fight over the Affordable Care Act or the larger cause, the movie may come as a real, and useful, shock to viewers who are more peripherally involved in its scathing portrait of deeply flawed economic incentives and treatment protocols.
There’s a lot of information, and a lot of storylines in Escape Fire. The two standouts are the journeys of Sgt. Robert Yates, who acts as an example of the dangers of overmedication, and Dr. Erin Martin, a promising physician who sees her career faltering under the pressures of a fee-for-service system.
When we meet Yates, he’s recovering from serious combat injuries in Afghanistan — mostly through an extremely heavy regimen of painkillers prescribed him by military doctors. On his flight home from the war to rehabilitation at Walter Reed, the doctors on his flight are shocked by the number and variety of drugs he’s been given, and the rate at which he’s consuming them. “These are all one person’s?” a doctor asks. Under their watch, he’s medicated himself to the point of insensibility, falling off his bunk, staggering towards the bathroom. At Walter Reed, he finally finds treatment that focuses on alleviating his psychological and physical pain through acupuncture and meditation. Yates admits he was skeptical, saying he was a “hold my beer while I shoot this gator” kind of guy. But the program works, helping him kick his drug dependency and get out of the wheelchair to which he’s been confined. “My very best friend from the war was on narcotics,” Yates tells us. “He overdosed…I lost him…I would rather be shot again than go through withdrawal from the medications.”
Dr. Martin, one of the many admirable physicians in Escape Fire is the kind of doctor Sgt. Yates — and the rest of us — should have regular access to but don’t. She quits one job because the demand that she shuffle through patients means she feels she isn’t adequately caring for them. A fellowship in Dr. Andrew Weil’s program (a real weakness of the movie is its failure to discuss the fact that some of Weil’s views lie outside the consensus of the medical community) at the University of Arizona revitalizes her faith in her profession and leads her to a job at a clinic that shares her philosophy. But even though the clinic is physician-owned, the iron hand of Medicaid reimbursements begins to make the way she wants to practice unsustainable, putting pressure on her colleagues who are willing to shave some time off of patient appointments to take on more work to pick up Dr. Martin’s share of the billing.
There are other stories here, too, ranging from an examination of the Cleveland Clinic’s treatment of a heart disease patient who is riddled with unnecessary stents but never got adequate health maintenance advice; to Dr. Steven Nissen’s discoveries about the dangers of diabetes drug Avandia; to the history of Dr. Dean Ornish’s preventative medicine programs for heart disease and prostate cancer patients. While this diversity will give almost any sympathetic viewer a story to latch on to, not all of the narratives achieve the same power as Yates’ and Martin’s, and the movie might have been better for streamlining slightly, blowing out their stories further and sacrificing others that make the same point. All the same, Escape Fire hammers home its point. The initial battle for health care reform may be won. But we’re far from the system — and the mindset — that we need.